This proposal will accelerate the tempo of scientific research of NIBIB RO1 EB002346, "Low-Cost Device for Digital Retinal Imaging," by means of Notice Number (NOT-OD-09-058) under the Notice Title: NIH Announces the Availability of Recovery Act Funds for Competitive Revision Applications. We are enhancing our novel design for a low cost Laser Scanning Digital Camera (LSDC), for use in diabetic retinopathy screening without pupil dilatation, by adding a motor and sensor on our focusing state that will provide the potential for autofocus, which will assist operators with little experience. Reducing the cost of operators is important in the per use cost of the device, allowing screening to be accomplished in a more cost effective manner. To reach the underserved, the LSDC does not require pupil dilation and yet provides a high contrast, digital image. The LSDC is designed to work well with small pupils and comfortable light level, producing continuous images to assist the operator during data acquisition. The use of near Infrared illumination provides this high contrast in all eye colors, so that minority subjects who have dark eyes still readily imaged with comfortable light levels. The proposed new autofocus feature automatically adds the potential for the LSDC serving as an autorefractor, a cataract detection device, and a retinal topographer to detect macular edema in an objective manner. We will test and optimize this device in subjects with a wide range of refractive errors and eye color, patients with cataract, and diabetic patients with retinopathy including macular edema. We will compare performance with that of age-matched and gender-matched normal control subjects. We will also compare the results of the new technology to that of high end devices, such as the IOL Master, spectral domain OCT, and wavefront aberrations. Our main goal is to provide high contrast retinal images in patients of all ethnic groups and including older patients for purposes of detection of diabetic retinopathy. The added functionality leads to greater energy efficiency because several functions can be accomplished in one instrument, saving on power, part count, footprint, and patient chair time. The data produced by this instrument will also provide a wealth of information to be used in the training of students. PUBLIC HEALTH RELEVANCE: We will modify our low cost retinal imaging device, the Laser Scanning Digital Camera, to investigate a low cost method to improve operator focus, measure refraction, investigate eye shape, quantify cataract, and quantify the severity of macular edema. Once developed, increased the functionality requires minimal added cost, providing energy efficiency by combining functions into a single device.